Fertility Problems: Exams and Tests

Testing for a cause of infertility usually starts with simple tests for both partners. In addition to an interview and physical examinations, your initial tests will check semen quality and both partners' hormone levels in the blood. Hormone imbalances can be a sign of ovulation or sperm production problems that can be treated.

Testing for a cause of infertility usually starts with simple tests for both partners. In addition to an interview and physical examinations, your initial tests will check semen quality and both partners' hormone levels in the blood. Hormone imbalances can be a sign of ovulation or sperm production problems that can be treated.

If your initial test results show no cause of infertility, your doctor may recommend checking fallopian tube function. Depending on your age and other risk factors, you may then be offered further testing or you may begin treatment with superovulation, intrauterine insemination, or both.

Commonly used tests for finding the cause of infertility

Who is tested

Type of test

The woman

- Charting basal body temperature (BBT) at home to identify ovulation phases, often for a few menstrual cycles before considering medical testing. Use a simple Fahrenheit temperature chart or Celsius temperature chart to track your temperature for a few months. Many doctors recommend that women use a home ovulation test kit to test luteinizing hormone (LH) levels in urine to confirm that ovulation occurs within 12 to 36 hours of your temperature increase.

Both the man and the woman

- Medical history and physical examination - Chlamydia test, because untreated chlamydia can cause female infertility and can infect a newborn at birth.

The man

- Semen analysis, to check the amount and quality of semen and sperm and for signs of infection. Abnormal test results are usually confirmed with another semen analysis, then followed with testosterone and FSH tests.

The man or the woman

Hormone tests, to check for a woman's ability to ovulate or a man's ability to produce sperm. These may include:

- Luteinizing hormone (LH). Abnormal LH levels can be a sign of female ovulation problems or male testosterone production problems. - Progesterone. Low progesterone levels can be a sign of ovulation problems. - Follicle-stimulating hormone (FSH), sometimes followed by a more specific clomiphene challenge test of the egg supply. High FSH levels may be a sign of low egg supply, or ovarian reserve; low FSH levels can prevent ovulation or, in men, sperm production. - Thyroid-stimulating hormone (TSH). Abnormal thyroid function can affect the menstrual cycle and ovulation. - Prolactin. High prolactin can be a sign of a pituitary problem, which can affect ovulation. - Testosterone. Low testosterone in men can cause sperm production problems. High levels in women can cause irregular menstrual periods.

No test provides absolute proof that the ovaries are releasing eggs. But basal body temperature charting, LH, and progesterone testing can provide b evidence of ovulation.

If the above tests are normal (sperm is within normal ranges and ovulation is regular), one of the following tests is often done next.

Other infertility tests

Who is tested

Type of test

The woman

- Pelvic ultrasound to study egg follicle development - Hysterosalpingogram or sonohysterogram (through the vagina) to check the uterus and fallopian tubes for signs of damage or structural problems - Hysteroscopy (through the vagina) to examine the uterus, sometimes done in addition to a hysterosalpingogram - Laparoscopy (through an abdominal incision) to look for and possibly repair conditions such as uterine fibroids, scarring from pelvic inflammatory disease, or endometriosis that can prevent pregnancy

If initial testing reveals no cause of infertility or if infertility treatment has been unsuccessful, one or more of the following tests are sometimes used.

Less common infertility tests

Who is tested

Type of test

Both the man and the woman

- Sperm antibody test to see whether the man's or woman's body is producing antibodies that impair the sperm, possibly preventing pregnancy

If initial testing reveals no cause of infertility or if infertility treatment has been unsuccessful, one or more of the following tests are occasionally used.

Rarely used infertility tests

Who is tested

Type of test

The man

Testicular biopsy (through an incision, rarely used) for men lacking sperm, to see if the fertility problem is linked to a sperm production problem in the testicles

Both the man and the woman

Genetic test, to see whether a genetic problem is contributing to infertility and/or to assess for possible genetic disorders that a parent could pass on to a child. Many, but not all, genetic conditions can currently be identified. Testing semen and cervical mucus, to check for infection that should be treated before trying to start a pregnancy